Ameliorating joint conditions including injuries and diseases

ABSTRACT

A method for ameliorating joint conditions and diseases and preventing bone hypertrophy can include facilitating cartilage regrowth and preventing bone overgrowth to a damaged bone at a treatment site within a body joint to promote healing. The method can include providing a device having a first section comprising a joint-ward end having an inner surface and an outer surface and fenestrations between the inner and outer surfaces. A second section can include an opposing leading end and a lateral wall extending between the joint-ward end and the leading end. The leading end can be penetrated into the bone to a depth to substantially position:1) the joint-ward end in a cartilage zone or at a boundary/transition area; and 2) the second section in the bone. Bone overgrowth into the cartilage zone may be prevented within the body joint when the device is positioned at the treatment site.

CROSS-REFERENCES TO RELATED APPLICATIONS

This application is a continuation of U.S. patent application Ser. No.16/840,132, entitled “Ameliorating Joint Conditions Including InjuriesAnd Diseases,” filed on Apr. 3, 2020, which is a continuation of U.S.patent application Ser. No. 15/148,894, entitled “Method ForAmeliorating Joint Conditions And Diseases And Preventing BoneHypertrophy,” filed on May 6, 2016; now U.S. Pat. No. 10,610,364; whichis a continuation-in-part of U.S. patent application Ser. No.14/603,586, entitled “Method and Device for Ameliorating JointConditions and Diseases,” filed on Jan. 23, 2015, now U.S. Pat. No.9,532,878; which is a divisional of U.S. patent application Ser. No.13/421,792, entitled “Method and Device for Ameliorating JointConditions and Diseases,” filed on Mar. 15, 2012, now U.S. Pat. No.8,968,404; which is a continuation-in-part of U.S. patent applicationSer. No. 12/328,493, entitled “Joint Support and Subchondral SupportSystem,” filed Dec. 4, 2008. U.S. patent application Ser. No. 15/148,894also claims the benefit of and priority to U.S. Patent Application62/260,030, entitled “Methods, Systems, and Devices for RepairingAnatomical Joint Conditions” filed on Nov. 25, 2015. The contents ofeach of the applications listed in this paragraph are incorporatedherein by reference in their entireties.

BACKGROUND OF THE INVENTION

There are a variety of conditions and diseases that impair the integrityand function of human joints. Among these joint conditions and diseasesare arthroses, chondromalacia patella, isolated chondral defect,juvenile idiopathic arthritis, ligamentous deficiency arthroses,osteoarthritis (degenerative arthritis or degenerative joint disease),osteonecrosis, osteochondritis dissecans, patellar instability,post-ligamentous injury arthritis, post-meniscectomy arthritis,post-meniscectomy arthroses, post-traumatic arthritis, rheumatoidarthritis and septic arthritis. The incidence of arthritides alone inthe United States exceeds 20%, with higher rates among women as comparedto men. Treatment of joint conditions and diseases includes surgery andthe administration of therapeutic agents. However, none of thesetreatments ameliorate all of the joint conditions and diseases.

Therefore, there is a need for a new method for ameliorating jointconditions and diseases.

BRIEF SUMMARY OF THE INVENTION

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. The devicecomprises a) a first section comprising a joint-ward end, an opposingmating end, and a lateral wall extending between the joint-ward end andthe mating end, where the first section further comprises a peripheralcolumn partially forming the lateral wall of the first section, acentral column, and three or more than three struts, each strutextending between and connecting the peripheral column and the centralcolumn, and each strut thereby supporting the central column, where thejoint-ward end further comprises a plurality of fenestrations, whereeach fenestration is formed by a confluence of the peripheral column,the central column and two adjacent struts of the three or more thanthree struts, and where the first section further comprises a centralaperture within and formed by the central column, and configured to matewith a driver, b) a second section comprising a mating end, an opposingleading end, and a lateral wall extending between the mating end and theleading end, where the lateral wall of the second section comprisesthreads.

In one embodiment, the device further comprises an axial length, and theaxial length is between 5 mm and 30 mm. In another embodiment, thedevice further comprises an axial length, and the axial length isbetween 5 mm and 20 mm. In another embodiment, the device furthercomprises an axial length, and the axial length is between 8 mm and 16mm. In one embodiment, the first section further comprises a diameterbetween 5 mm and 30 mm. In another embodiment, the first section furthercomprises a diameter between 5 mm and 20 mm. In another embodiment, thefirst section further comprises a diameter between 8 mm and 16 mm. Inanother embodiment, the first section further comprises an axial lengthbetween 1 mm and 2 mm.

In one embodiment, each fenestration comprises a pear or teardrop shape.In another embodiment, one or more than one fenestration comprises adifferent size, different shape or both a different size and a differentshape than one or more than one other fenestration.

In one embodiment, the central aperture comprises a six-pointed starshape. In another embodiment, the central aperture is round andcomprises threads. In one embodiment, the peripheral column comprisesone or more than one notch.

In one embodiment, the joint-ward end comprises a convex profile as seenon a cross-sectional, lateral perspective view. In another embodiment,the joint-ward end comprises a concave profile as seen on across-sectional, lateral perspective view. In another embodiment, thejoint-ward end comprises a straight profile as seen on across-sectional, lateral perspective view. In one embodiment, thejoint-ward end comprises a radius of curvature of between 20 mm and 50mm. In another embodiment, the joint-ward end comprises a radius ofcurvature of between 15 mm and 45 mm. In another embodiment, the lateralwall of the first section comprises a generally convex profile as seenon a cross-sectional, lateral perspective view.

In one embodiment, the second section further comprises an axial lengthbetween 5 mm and 30 mm. In another embodiment, the second sectionfurther comprises an axial length between 5 mm and 20 mm. In anotherembodiment, the second section further comprises an axial length between6 mm and 15 mm. In one embodiment, the lateral wall of the secondsection is generally cylindrical. In another embodiment, the lateralwall of the second section is generally conical, tapering between themating end and the leading end. In one embodiment, the lateral wall ofthe second section tapers between 0.2 degrees and 15 degrees. In anotherembodiment, the lateral wall of the second section tapers between 1degrees and 5 degrees. In another embodiment, the lateral wall of thesecond section tapers between 1 degrees and 3 degrees.

In one embodiment, the mating end of the first section and the matingend of the second section mate by a biocompatible adhesive. In anotherembodiment, the mating end of the first section and the mating end ofthe second section mate by a mating mechanism that is reversible. Inanother embodiment, the mating end of the first section and the matingend of the second section mate by a reversible twist locking mechanism.In another embodiment, the first section and the second section are madeas a unified whole.

In one embodiment, the leading end comprises a scalloped edge. Inanother embodiment, the leading end comprises bevels. In anotherembodiment, the leading end comprises both a scalloped edge and bevels.

In one embodiment, the lateral wall of the second section furthercomprises a plurality of fenestrations between the threads. In anotherembodiment, the device further comprises a plurality of fenestrationsformed by a confluence of the mating end of the first section and themating end of the second section. In one embodiment, the device furthercomprises an insert, where the insert comprises a base and three or morethan three extensions connected to the base and arranged radially aroundthe base, and where each of the three or more than three extensions isconfigured to fit within a corresponding fenestration of the joint-wardend of first section of the device. In one embodiment, the insertfurther comprises porous biological material impregnated withmatrix-promoting substances or serves as a scaffold for progenitorcells, or comprises both porous biological material impregnated withmatrix-promoting substances and serves as a scaffold for progenitorcells.

According to another embodiment of the present invention, there isprovided a method for ameliorating a joint condition or disease in apatient. The method comprises a) identifying a patient with a jointcondition or disease that is suitable for treatment by the method, wherethe joint comprises a bone with a surface comprising a defect caused bythe joint condition or disease, b) accessing the joint, c) placing aguidepin within the center of the defect, d) creating a space in thedefect of the bone, e) providing a first device according to the presentinvention, f) attaching the first device to a driver by mating thedistal end of the driver with the central aperture of the first device,and g) screwing the first device into the space using the driver untilthe joint-ward end of the first device forms a shape that substantiallyrecreates the shape of a normal articulation surface on the bone afterimplantation.

In one embodiment, the joint is a diarthrodial joint. In anotherembodiment, the joint is selected from the group consisting of anacetabulofemoral joint, an acromioclavicular joint, a femoropatellarjoint, a femorotibial joint, a glenohumeral joint, a humeroradial joint,a humeroulnar joint, an interphalangeal joint, a metacarpal joint, aradioulnar joint and a talocrural joint. In one embodiment, the patientis a human. In one embodiment, the patient is a non-human animal. In oneembodiment, the joint condition and disease is selected from the groupconsisting of arthroses, chondromalacia patella, isolated chondraldefect, juvenile idiopathic arthritis, ligamentous deficiency arthroses,osteoarthritis (degenerative arthritis or degenerative joint disease),osteonecrosis, osteochondritis dissecans, patellar instability,post-ligamentous injury arthritis, post-meniscectomy arthritis,post-meniscectomy arthroses, post-traumatic arthritis, rheumatoidarthritis and septic arthritis.

In one embodiment, identifying the patient comprises diagnosing thepatient with a joint condition and disease. In another embodiment,diagnosing the patient comprises performing one or more than one ofaction selected from the group consisting of performing a physicalexamination, performing a non-invasive imaging examination andperforming arthroscopy. In one embodiment, identifying the patientcomprises consulting patient records to determine if the patient has ajoint condition or disease suitable for treatment by the method. In oneembodiment, accessing the joint is accomplished by arthroscopy. In oneembodiment, the joint is accomplished by an open surgical procedure.

In one embodiment, the surface of the bone comprises one or more thanone abnormality, and the method further comprises using a burr, or asuction shaver, or both a burr and a suction shaver to remove some orall of the one or more than one abnormality thereby creating a smootherarticulation surface. In one embodiment, the method further comprisescreating one or more than one vascular channel in the bone deep to thespace using a drill bit guide positioned over the guidepin and a drillbit passed within the drill bit guide. In another embodiment, the methodfurther comprises injecting a biological material into the first device.In one embodiment, the method further comprises placing an insert in thefirst device. In one embodiment, the method further comprises placingone or more than one additional device in the defect.

According to yet another embodiment, there is provided a method offacilitating cartilage regrowth and preventing bone overgrowth to adamaged bone at a treatment site within a body joint to promote healing.The method comprises providing a device having a first sectioncomprising a joint-ward end having an inner surface and an outer surfaceand fenestrations between the inner and outer surfaces and a secondsection comprising an opposing leading end and a lateral wall extendingbetween the joint-ward end and the leading end. The leading end ispenetrated into the bone to a depth to substantially position: 1) thejoint-ward end in a cartilage zone; wherein the outer surface of thejoint-ward end is configured to facilitate cartilage regrowth; and 2)the second section in the bone; wherein the inner surface of thejoint-ward end is configured to prevent bone overgrowth into thecartilage zone within the body joint when the device is positioned atthe treatment site.

According to other embodiments, the device is positioned and configuredto provide active or passive dampening support to the bone at thetreatment site so as to dissipate and dampen shock within the bone topromote healing. The second section includes fenestrations, thefenestrations are configured to promote osseointegration of the secondsection at the treatment site. The joint-ward end is substantiallypositioned at a transition area between a cartilage layer and a bonelayer such that cartilage can grow through, around and over thefenestrations in the joint-ward end. The cartilage is articularcartilage and healing includes mitigating bone hypertrophy. Thefenestrations promote intracellular nutrient transmission. Thetransition area is located substantially in a cortical bone base plateor located substantially between cancellous bone and a cartilage zone.The device inhibits bone growth into a cartilage zone when the device ispositioned at the treatment site. The device also prevents bone fracturewhen the device is positioned at the treatment site. The body joint maybe a knee and the treatment site may include a subchondral lesion.Mitigating bone hypertrophy may include preventing trabecular thickeningof the cancellous bone, for example. A thickness of cartilage regrowthat the treatment site is substantially uniform after healing and/or issubstantially the same as a thickness of healthy cartilage adjacent thetreatment site after healing. The device is made of titanium and atleast the outer surface of the joint-ward end is coated withhydroxyapatite. The first section and second section may be reversiblyattached or fused together.

BRIEF DESCRIPTION OF THE DRAWINGS

These and other features, aspects and advantages of the presentinvention will become better understood with regard to the followingdescription, appended claims, and accompanying figures where:

FIG. 1 is a lateral perspective view of one embodiment of a device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 2 is a top, lateral perspective view of another embodiment of adevice for ameliorating joint conditions and diseases according to thepresent invention;

FIG. 3 is an exploded, top, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 1;

FIG. 4 is a top perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 1;

FIG. 5 is a bottom perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 1;

FIG. 6 is a top perspective view of the embodiment of the device forameliorating joint conditions and diseases shown in FIG. 2;

FIG. 7 is a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 8 is a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 9 is a cross-sectional, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 1 taken along line 9-9;

FIG. 10 is a cross-sectional, lateral perspective view of anotherembodiment of the device for ameliorating joint conditions and diseasesaccording to the present invention;

FIG. 11 is a cross-sectional, lateral perspective view of the embodimentof the device for ameliorating joint conditions and diseases shown inFIG. 2 taken along line 11-11;

FIG. 12 is a top, lateral perspective view of one embodiment of aninsert according to the present invention for use with a device forameliorating joint conditions and diseases according to the presentinvention;

FIG. 13 is a bottom, lateral perspective view of the embodiment of theinsert shown in FIG. 12;

FIG. 14 is a top, lateral perspective view of one embodiment of thedevice for ameliorating joint conditions and diseases shown in FIG. 1with the insert shown in FIG. 12 according to the present inventionaffixed to the device;

FIG. 15 is a cross-sectional view of the device for ameliorating jointconditions and diseases shown in FIG. 1 with the insert shown in FIG. 12according to the present invention affixed to the device; and

FIG. 16 through FIG. 35 are schematic depictions of some steps of amethod for ameliorating joint conditions and diseases according to thepresent invention.

FIG. 36 is a cross-sectional view of anatomical regions at a treatmentsite.

FIG. 37A is a cross-sectional view of a lesion in a damaged bone.

FIG. 37B is a cross-sectional view of cartilage growth overhypertrophied bone.

FIG. 38A is an embodiment of the device according to the presentinvention.

FIG. 38B is an embodiment of the device according to the presentinvention showing cartilage growth during healing.

DETAILED DESCRIPTION OF THE INVENTION

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. According toanother embodiment of the present invention, there is provided a methodfor ameliorating a joint condition or disease in a patient. In oneembodiment, the method comprises providing a device according to thepresent invention. The device and methods will now be disclosed indetail.

As used in this disclosure, except where the context requires otherwise,the term “comprise” and variations of the term, such as “comprising,”“comprises” and “comprised” are not intended to exclude other additives,components, integers or steps.

As used in this disclosure, except where the context requires otherwise,the method steps disclosed and shown are not intended to be limiting norare they intended to indicate that each step is essential to the methodor that each step must occur in the order disclosed but instead areexemplary steps only.

All dimensions specified in this disclosure are by way of example onlyand are not intended to be limiting, except where the context requiresotherwise. Further, the proportions shown in these Figures are notnecessarily to scale. As will be understood by those with skill in theart with reference to this disclosure, the actual dimensions andproportions of any device or part of a device disclosed in thisdisclosure will be determined by its intended use.

According to one embodiment of the present invention, there is provideda device for ameliorating joint conditions and diseases. Referring nowto FIG. 1 through FIG. 11, there are shown, respectively, a lateralperspective view of one embodiment of a device for ameliorating jointconditions and diseases according to the present invention (FIG. 1); atop, lateral perspective view of another embodiment of a device forameliorating joint conditions and diseases according to the presentinvention (FIG. 2); an exploded, top, lateral perspective view of theembodiment of the device for ameliorating joint conditions and diseasesshown in FIG. 1 (FIG. 3); a top perspective view of the embodiment ofthe device for ameliorating joint conditions and diseases shown in FIG.1 (FIG. 4); a bottom perspective view of the embodiment of the devicefor ameliorating joint conditions and diseases shown in FIG. 1 (FIG. 5);a top perspective view of the embodiment of the device for amelioratingjoint conditions and diseases shown in FIG. 2 (FIG. 6); a topperspective view of another embodiment of the device for amelioratingjoint conditions and diseases according to the present invention (FIG.7); a top perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention (FIG. 8); a cross-sectional, lateral perspective view of theembodiment of the device for ameliorating joint conditions and diseasesshown in FIG. 1 taken along line 9-9 (FIG. 9); a cross-sectional,lateral perspective view of another embodiment of the device forameliorating joint conditions and diseases according to the presentinvention (FIG. 10); and a cross-sectional, lateral perspective view ofthe embodiment of the device for ameliorating joint conditions anddiseases shown in FIG. 2 taken along line 11-11 (FIG. 11). As can beseen, the device 10 comprises a first section 12 and a second section14, and comprises a generally cylindrical shape partially or completelyclosed at one end. The device 10 further comprises an axial length(a-a). In one embodiment, the axial length (a-a) is between 5 mm and 30mm. In another embodiment, the axial length (a-a) is between 5 mm and 20mm. In another embodiment, the axial length (a-a) is between 8 mm and 16mm. In a preferred embodiment, the axial length (a-a) is 8 mm. Inanother preferred embodiment, the axial length (a-a) is 12 mm. Inanother preferred embodiment, the axial length (a-a) is 16 mm.

The first section 12 of the device 10 comprises a joint-ward end 16, anopposing mating end 18, and a lateral wall 20 extending between thejoint-ward end 16 and the mating end 18. The first section 12 furthercomprises a diameter (d-d) and an axial length (b-b). In one embodiment,the diameter (d-d) is between 5 mm and 30 mm. In another embodiment, thediameter (d-d) is between 5 mm and 20 mm. In another embodiment, thediameter (d-d) is between 8 mm and 16 mm. In a preferred embodiment, thediameter (d-d) is 8 mm. In another preferred embodiment, the diameter(d-d) is 12 mm. In another preferred embodiment, the diameter (d-d) is16 mm. In one embodiment, the axial length (b-b) is between 0.5 mm and2.5 mm. In another embodiment, the axial length (b-b) is between 1 mmand 2 mm. In a preferred embodiment, the axial length (b-b) is 1.25 mm.

In one embodiment, the first section 12 further comprises a peripheralcolumn 22 partially forming the lateral wall 20, a central column 24,and three or more than three struts 26, each strut 26 extending betweenand connecting the peripheral column 22 and the central column 24, andeach strut 26 thereby supporting the central column 24.

In one embodiment, the joint-ward end 16 further comprises a pluralityof fenestrations 28, where each fenestration 28 is formed by aconfluence of the peripheral column 22, the central column 24, and twoadjacent struts 26 of the three or more than three struts 26. Eachfenestration 28 can comprise any shape suitable for the intended purposeof the device 10, as will be understood by those with skill in the artwith respect to this disclosure. In one embodiment, as shownparticularly in FIG. 2, FIG. 3, FIG. 4, FIG. 5, FIG. 6 and FIG. 7, eachfenestration 28 comprises a pear or teardrop shape. In anotherembodiment, as shown in FIG. 8, each fenestration 28 comprises a kidneyshape. In another embodiment, each fenestration 28 comprises an oval ora round shape. As will be understood by those with skill in the art withrespect to this disclosure, all fenestrations 28 on the device 10 cancomprise the same size and shape or one or more than one fenestration 28can comprise a different size, different shape or both a different sizeand a different shape than one or more than one other fenestration 28.In another embodiment, the joint-ward end 16 can be solid between thecentral column 24 and the peripheral column 22.

The first section 12 further comprises a central aperture 30 within andformed by the central column 24. The central aperture 30 can extendaxially completely through the joint-ward end 16 as shown particularlyin FIG. 9, FIG. 10 and FIG. 11, or can be blind-ended extending onlypartially through within joint-ward end 16. The central aperture 30 isconfigured to mate with a driver as disclosed below. The centralaperture 30 comprises any shape suitable for the intended purpose of thedevice 10, as will be understood by those with skill in the art withrespect to this disclosure. In one embodiment, the central aperture 30comprises a square shape. In one embodiment, as shown in FIG. 2 and FIG.6, the central aperture 30 comprises a round shape. In anotherembodiment, as shown in FIG. 3, FIG. 4 and FIG. 5, the central aperture30 comprises a six-pointed star shape. In another embodiment, as shownin FIG. 7, the central aperture 30 comprises a pentagonal shape. Inanother embodiment, as shown in FIG. 8, the central aperture 30comprises a hexagonal shape. In one embodiment, as shown in FIG. 2 andFIG. 11, the central aperture 30 comprises threads 32 to assist inmating with a driver.

In one embodiment, peripheral column 22 of the first section 12comprises one or more than one notch 34 as seen in FIG. 2, FIG. 6 andFIG. 11. The one or more than one notch can be used to mate with adriver in addition to the central aperture 30 or instead of the centralaperture 30, as will be understood by those with skill in the art withrespect to this disclosure.

The joint-ward end 16 of the first section 12 of the device 10 performsa partial load-bearing function after implantation, and comprises ashape suitable to substantially match the shape of the articulationsurface that the device 10 recreates on the bone after implantation, aswill be understood by those with skill in the art with respect to thisdisclosure. Therefore, the joint-ward end 16 can have either a convexprofile as seen on a cross-sectional, lateral perspective view, as shownin FIG. 9 and FIG. 11, a concave profile as seen on a cross-sectional,lateral perspective view, as shown in FIG. 10, or a straight profile asseen on a cross-sectional, lateral perspective view. In one embodiment,the joint-ward end has a convex profile having a radius of curvature ofbetween 10 mm and 50 mm. In another embodiment, the joint-ward end has aconvex profile as seen on a cross-sectional, lateral perspective viewwith a radius of curvature of between 15 mm and 45 mm. In anotherembodiment, the joint-ward end has a convex profile as seen on across-sectional, lateral perspective view with a radius of curvature ofbetween 20 mm and 30 mm. In one embodiment, the joint-ward end has aconcave profile as seen on cross-sectional, lateral perspective viewwith a radius of curvature of between 10 mm and 50 mm. In anotherembodiment, the joint-ward end has a concave profile as seen oncross-sectional, lateral perspective view with a radius of curvature ofbetween 15 mm and 45 mm. In another embodiment, the joint-ward end has aconcave profile as seen on cross-sectional, lateral perspective viewwith a radius of curvature of between 20 mm and 30 mm. In a preferredembodiment, the joint-ward end 16 comprises a smooth surface facing thecenter of joint after implantation, as will be understood by those withskill in the art with respect to this disclosure. In a preferredembodiment, the joint-ward end 16 is polished to make the surfacesmooth.

The lateral wall 20 of the first section 12 can be any shape suitablefor the intended purpose of the device 10, as will be understood bythose with skill in the art with respect to this disclosure. In apreferred embodiment, the lateral wall 20 of the first section 12comprises a generally convex profile as seen on a cross-sectional,lateral perspective view, as shown in FIG. 9 and FIG. 11. This convexprofile advantageously provides a smooth transition to and encouragesbiologic bonding to surrounding cartilage and bone after implantation,as will be understood by those with skill in the art with respect tothis disclosure.

The device 10 further comprises a second section 14. The second section14 of the device 10 comprises a mating end 36, an opposing leading end38, and a lateral wall 40 extending between the mating end 36 and theleading end 38. The second section 14 further comprises an axial length(c-c). In one embodiment, the axial length (c-c) is between 5 mm and 30mm. In another embodiment, the axial length (c-c) is between 5 mm and 20mm. In another embodiment, the axial length (c-c) is between 6 mm and 15mm. In a preferred embodiment, the axial length (c-c) is 6 mm. Inanother preferred embodiment, the axial length (c-c) is 10 mm. Inanother preferred embodiment, the axial length (c-c) is 15 mm. In oneembodiment, the lateral wall 40 of the second section 14 is generallycylindrical as seen in FIG. 1, FIG. 9 and FIG. 10. In anotherembodiment, the lateral wall 40 of the second section 14 is generallyconical, tapering between the mating end 36 and the leading end 38 asseen in FIG. 11. In one embodiment, the lateral wall 40 of the secondsection 14 tapers between 0.2 degrees and 15 degrees. In anotherembodiment, the lateral wall 16 tapers between 1 degrees and 5 degrees.In another embodiment, the lateral wall 40 of the second section 14tapers between 1 degrees and 3 degrees.

The mating end 36 of the second section 14 of the device 10 isconfigured to mate with the mating end 18 of the first section 12 of thedevice 10. The mating end 18 of the first section 12 and the mating end36 of the second section 14 can comprise any mating mechanism suitablefor the intended purpose of the device 10 can be used, as will beunderstood by those with skill in the art with respect to thisdisclosure. In one embodiment, the mating end 18 of the first section 12and the mating end 36 of the second section 14 mate by a suitablebiocompatible adhesive, as will be understood by those with skill in theart with respect to this disclosure. In a preferred embodiment, themating mechanism is reversible, allowing an interchange of an alternatefirst section 12 to a specific second section 14 so that the device 10can be reconfigured as needed for contouring to a particular jointsurface, thereby decreasing the number of second sections 14 that needto be stored on site, as will be understood by those with skill in theart with respect to this disclosure. In one embodiment, the mating end18 of the first section 12 and the mating end 36 of the second section14 mate by a reversible twist locking mechanism, as will be understoodby those with skill in the art with respect to this disclosure. Inanother embodiment, the first section 12 and the second section 14 aremade as a unified whole as shown in FIG. 11 and are not separable.

The leading end 38 of the second section 14 of the device 10 isconfigured to place the device 10 into a prepared space made accordingto a method according to the present invention. In one embodiment, theleading end 38 comprises a scalloped edge 42. In another embodiment, theleading end 38 comprises bevels 44. In a preferred embodiment, theleading end 38 comprises both a scalloped edge 42 and bevels 44 as shownparticularly in FIG. 1, FIG. 3, FIG. 5 and FIG. 6.

The lateral wall 40 of the second section 14 of the device 10 extendsbetween the mating end 36 and the leading end 38. The lateral wall 40 ofthe second section 14 comprises threads 46 for anchoring the device 10within the bone. In one embodiment, the lateral wall 40 of the secondsection 14 further comprises a plurality of fenestrations 48 between thethreads 46. In a preferred embodiment, the device 10 further comprises aplurality of fenestrations 50 formed by a confluence of the mating end18 of the first section 12 and the mating end 36 of the second section14. Each fenestration 48, 50 can comprise any shape suitable for theintended purpose of the device 10, as will be understood by those withskill in the art with respect to this disclosure. In a preferredembodiment, each fenestration 48, 50 is oval or round. In oneembodiment, the lateral wall 40 of the second section 14 is textured topromote bony ingrowth after implantation, as will be understood by thosewith skill in the art with respect to this disclosure.

The first section 12 and the second section 14 can comprise any materialsuitable for the intended purpose of the device 10, as will beunderstood by those with skill in the art with respect to thisdisclosure. In one embodiment, the first section 12 comprises a materialselected from the group consisting of a biocompatible plastic, abiocomposite polymer, a metal and a metal alloy. In one embodiment, thefirst section 12 comprises a material selected from the group consistingof carbon fiber, cobalt chrome, nitinol, polycaprolactone (PCL),polyether-ether-ketone (PEEK), tantalum and titanium. In one embodiment,the second section 14 comprises a material selected from the groupconsisting of a biocompatible plastic, a biocomposite polymer, a metaland a metal alloy. In one embodiment, the second section 14 comprises amaterial selected from the group consisting of carbon fiber, cobaltchrome, nitinol, polycaprolactone (PCL), polyether-ether-ketone (PEEK),tantalum and titanium. In one embodiment, the first section 12 comprisesa first material and the second section 14 comprises a second material,where the first material and the second material are the same material.In another embodiment, the first section 12 comprises a first materialand the second section 14 comprises a second material, where the firstmaterial and the second material are the different materials.

In one embodiment, the device 10 further comprises an insert 52.Referring now to FIG. 12, FIG. 13, FIG. 14 and FIG. 15, there are shown,respectively, a top, lateral perspective view of one embodiment of aninsert according to the present invention for use with a device forameliorating joint conditions and diseases according to the presentinvention (FIG. 12); a bottom, lateral perspective view of theembodiment of the insert shown in FIG. 12 (FIG. 13); a top, lateralperspective view of one embodiment of the device for ameliorating jointconditions and diseases shown in FIG. 1 with the insert shown in FIG. 12according to the present invention affixed to the device (FIG. 14); anda cross-sectional view of the device for ameliorating joint conditionsand diseases shown in FIG. 1 with the insert shown in FIG. 12 (FIG. 15).As can be seen, the insert 52 comprises a base 54 and three or more thanthree extensions 56 connected to the base 54 and arranged radiallyaround the base 54. Each of the three or more than three extensions 56is configured to fit within a corresponding fenestration 28 of thejoint-ward end 16 of the first section 12 of the device 10, such thatwhen the insert 52 is mated to the first section 12 of the device 10,the insert 52 occupies each of the three or more than threefenestrations 28 as shown particularly in FIG. 5. The insert 52comprises porous biological material impregnated with matrix-promotingsubstances or serves as a scaffold for progenitor cells, or comprisesboth porous biological material impregnated with matrix-promotingsubstances and serves as a scaffold for progenitor cells.

The device 10 can be made by any suitable method, as will be understoodby those with skill in the art with respect to this disclosure. In oneembodiment, the first section 12 and the second section 14 are machinedfrom modular parts such as by direct metal laser sintering, as will beunderstood by those with skill in the art with respect to thisdisclosure.

According to another embodiment of the present invention, there isprovided a method for ameliorating a joint condition or disease in apatient. Referring now to FIG. 16 through FIG. 35, there are shownschematic depictions of some steps of a method for ameliorating jointconditions and diseases according to the present invention. The Figuresshow the embodiment of the method being used on a femorotibial joint 100to ameliorate an arthritic condition which has caused a defect 102 on anarticulation surface 104 of a bone or joint, shown here as on the medialcondyle 106 of the femur 108.

The method comprises identifying a patient with a joint condition ordisease that is suitable for treatment by the present method, where thejoint comprises a bone with a surface comprising a defect caused by thejoint condition or disease. As will be understood by those with skill inthe art with respect to this disclosure, the joint can be any joint witha hyaline cartilage bearing surface, joint capsule, and synovial fluid.In one embodiment, the joint is a diarthrodial joint (also known as asynovial joint). In one embodiment, the joint is selected from the groupconsisting of an acetabulofemoral joint, an acromioclavicular joint, afemoropatellar joint, a femorotibial joint, a glenohumeral joint, ahumeroradial joint, a humeroulnar joint, an interphalangeal joint, ametacarpal joint, a radioulnar joint and a talocrural joint. In oneembodiment, the patient is a human. In one embodiment, the patient is anon-human animal. In a preferred embodiment, the joint condition anddisease is selected from the group consisting of arthroses,chondromalacia patella, isolated chondral defect, juvenile idiopathicarthritis, ligamentous deficiency arthroses, osteoarthritis(degenerative arthritis or degenerative joint disease), osteonecrosis,osteochondritis dissecans, patellar instability, post-ligamentous injuryarthritis, post-meniscectomy arthritis, post-meniscectomy arthroses,post-traumatic arthritis, rheumatoid arthritis and septic arthritis. Inone embodiment, identifying the patient comprises diagnosing the patientwith a joint condition and disease. In one embodiment, diagnosing thepatient comprises performing one or more than one of action selectedfrom the group consisting of performing a physical examination,performing a non-invasive imaging examination (such as magneticresonance imaging, computerized tomography and ultrasound) andperforming arthroscopy. In another embodiment, identifying the patientcomprises consulting patient records to determine if the patient has ajoint condition or disease suitable for treatment by the present method.

Next, the method further comprises accessing the joint 100. In oneembodiment, accessing the joint 100 is accomplished by arthroscopy. Inanother embodiment, accessing the joint 100 is accomplished by an opensurgical procedure, such as for example a mini-open procedure.

In one embodiment, as shown in FIG. 17 and FIG. 18, the surface 104 ofthe bone comprises an abnormality 110 (such as for example areacartilage softening, thinning, damage, or absence), and the methodfurther comprises using a burr, or a suction shaver, or both a burr anda suction shaver 112 to remove some or all of the abnormalities 110thereby creating a smoother articulation surface 104 as shown in FIG.19.

Then, the method further comprises placing a guidepin 114 within thecenter of the defect 102 as shown in FIG. 20.

Next, the method further comprises creating a space 116 in the defect102 of the bone for a device. In one embodiment, the space 116 iscreated using a bone reamer 118 placed over the guidepin 114 to core andplane the surface of the defect 102 as shown in FIG. 21, FIG. 22 andFIG. 23. The bone reamer 118 is then removed leaving the guidepin 114 inplace.

In one embodiment, the method further comprises creating one or morethan one vascular channel in the bone deep to the space 116 using adrill bit guide 120 positioned over the guidepin 114 and a drill bit 122passed within the drill bit guide 120 as shown in FIG. 23, FIG. 24 andFIG. 25. Confirmation of creation of the one or more than one vascularchannel is made by the presence of blood 124 leaking into the space 116from the one or more than one vascular channel. The drill bit guide 120and drill bit 122 are then removed leaving the guidepin 114 in place.

Next, the method further comprises providing a first device 126 forameliorating joint conditions and diseases suitable for ameliorating thejoint condition or disease of the patient as can be seen in FIG. 26. Inone embodiment, the first device 126 is a device according to thepresent invention. The first device 126 provided has a size suitable forincorporation into the space 116 made in the defect 102, and thejoint-ward end of the first device 126 comprises a shape suitable tosubstantially match the shape of the articulation surface 104 that thefirst device 126 recreates on the bone after implantation, as will beunderstood by those with skill in the art with respect to thisdisclosure. Referring now to FIG. 27, the first device 126 is attachedto a driver 128, such as for example by mating the distal end of thedriver 128 with the central aperture of the first device 126.

In one embodiment, the method further comprises injecting a biologicmaterial, such as for example stem cells or platelet rich plasma, orboth stem cells and platelet rich plasma 130 into the first device 126using an injector 132 as shown in FIG. 28. In one embodiment, the methodfurther comprises placing an insert according to the present inventionin the first device 126 instead of injecting a biocompatible bone cementin the first device 126. In one embodiment, the insert is a biologicalmaterial according to the present invention.

Then, the method further comprises screwing the first device 126 intothe space 116 using the driver 128, as shown in FIG. 29, FIG. 30, FIG.31 and FIG. 32. FIG. 33 is a partial, lateral cross-section of themedial condyle 106 at the site of the defect 102 showing placement ofthe first device 126. As can be seen, the joint-ward end of the firstdevice 126 forms a shape that substantially recreates the shape of anormal articulation surface on the bone after implantation.

In one embodiment, as can be seen in FIG. 26 and FIG. 34, the methodfurther comprises placing one or more than one additional device 134,136 in the defect 102. In one embodiment, the one or more than oneadditional device is one additional device. In another embodiment, oneor more than one additional device is two additional devices. As will beunderstood by those with skill in the art with respect to thisdisclosure, the one or more than one additional device 134, 136 can bethe same as the first device in terms of size and shape or can bedifferent than the first device in terms of size and shape.

FIG. 36 shows a cross-sectional view of anatomical regions at a damagedbone 146. The regions include cancellous bone 137, a cortical bone baseplate 138, and a cartilage zone 139. The cartilage zone 139 may includearticular cartilage. Torn cartilage 140 is shown near an injury site141.

Under natural healing conditions without medical intervention, thecortical bone base plate 138 tends to grow past a boundary/transition143 of the cartilage zone 139 in a direction 142 toward the articulatingbody joint at the injury site 141 as shown in FIGS. 36 and 37A, forexample. Under these conditions, it is not unusual to observe trabecularthickening of the cancellous bone as the body tries to compensate andprotect against forces applied to the joint as it heals. As healingprogresses without intervention, bone hypertrophy continues and one ormore boney outcrops 144 often form which, in turn, leaves a cartilagelayer 145 a that is relatively thin and generally less healthy than athickness of pristine cartilage adjacent 147 a, 147 b the damaged bone146, as illustrated in FIG. 37B. Unfortunately, this often results insuboptimal healing for the patient—leaving the bone vulnerable toadditional trauma and the body joint subject to repeated injuries.

An embodiment of the present invention includes a new, useful andnon-obvious method of facilitating cartilage regrowth and preventingbone overgrowth to a damaged bone at a treatment site within a bodyjoint to promote healing and avoid the scenario described above andshown in FIGS. 37A and 37B.

With reference to FIGS. 3 and 38A, an embodiment of the device accordingto the present invention is disclosed. The device 10 has a first section12 comprising a joint-ward end 16 having an inner surface 16 a and anouter surface 16 b and fenestrations 28 between the inner 16 a and outer16 b surfaces. A second section 14 comprises an opposing leading end 38and a lateral wall 40 extending between the joint-ward end 16 and theleading end 38. The leading end 38 is penetrated into the bone to adepth to substantially position: 1) the joint-ward end 16 in a cartilagezone 139; wherein the outer surface of the joint-ward end 16 isconfigured to facilitate cartilage regrowth; and 2) the second section14 in the bone 137; wherein the inner surface 16 a of the joint-ward end16 is configured to prevent bone overgrowth into the cartilage zone 139within the body joint when the device is positioned at the treatmentsite. Thus, as shown in FIG. 38B, optimal healing is advanced bymitigating bone hypertrophy and facilitating cartilage regrowth.Mitigating bone hypertrophy may include preventing trabecular thickeningof the cancellous bone. Per FIG. 38B, cartilage may be encouraged toregrow over the injured bone at a thickness 145 b at the treatment sitethat is substantially uniform after healing and may also besubstantially the same as a thickness of healthy (i.e. pristine)cartilage adjacent 147 a, 147 b the treatment site after healing. Inthis manner, a patient progresses to a more optimal healed state. Thebone is better protected from additional trauma and is less likely tofracture when the device is positioned at the treatment site. The bodyjoint is also less likely to experience repeated subsequent injuries.

Advantageously, the device 10 is positioned and configured to provideactive or passive dampening support to the bone at the treatment/injurysite 141 so as to dissipate and dampen shock within the bone to promotehealing. This may prevent excessive thickening of the cancellous bone.The second section 14 includes fenestrations 48 and these fenestrationsare configured to promote osseointegration of the second section at thetreatment site. This provides stability. Furthermore, as discussed inU.S. Patent Application 62/260,030, entitled “Methods, Systems, andDevices for Repairing Anatomical Joint Conditions” filed on Nov. 25,2015, which is pending, the contents of which are incorporated herein byreference, the fenestrations may have different porosities targeted topromote specific tissue growth and differentiation. For example, thefenestrations may be different sizes conducive to facilitating cartilageregrowth on outer surface 16 b of the joint-ward end 16 and to preventbone overgrowth into the cartilage zone 139 within the body joint on theinner surface 16 a of the joint-ward end 16. The joint-ward end 16 maybe substantially positioned at a boundary/transition area 143 between acartilage layer and a bone layer such that cartilage can grow throughand around and even over the top of the fenestrations 28 in thejoint-ward end 16. The transition area 143 may be located substantiallyin a cortical bone base plate or located substantially betweencancellous bone and a cartilage zone, for example.

The plurality of fenestrations between the protrusions (e.g. treads,notches) 46 on the second section of the lateral wall are between about300 microns and 1200 microns in size to promote bone growth while theplurality of fenestrations on the joint-ward end of the first sectionare between about 100 microns to 800 microns in size to promotecartilage growth. Preferably, the plurality of fenestrations on thejoint-ward end 16 of the first section are between about 400 microns to800 microns in size to promote cartilage growth. Circular pores,pie-shaped fenestrations and other shapes are considered.

Though the method of the present invention has been disclosed withrespect to a defect 102 in a femorotibial joint 100, correspondingmethods can be used with other joints. FIG. 35 is a partial, lateralcross-section of a glenohumeral joint 138 at the site of a defectshowing placement of a device for ameliorating joint conditions anddiseases according to the present invention.

Although the present invention has been discussed in considerable detailwith reference to certain preferred embodiments, other embodiments arepossible. Therefore, the scope of the appended claims should not belimited to the description of preferred embodiments contained in thisdisclosure.

1. A method of promoting healing in or adjacent to a portion of a bonelayer at a treatment site within a body joint, the method comprising:providing an implantable device having a body formed of material, theimplantable device comprising: an axis defining an axial direction ofthe device; a first section comprising: a joint-ward end having an innersurface and an outer surface spaced apart from one another along theaxial direction of the device, the joint-ward end further having firstfenestrations extending fully through the joint-ward end in a mannerthat includes extending between and through the inner surface of thejoint-ward end and the convex or concave profile of the outer surface ofthe joint-ward end; and a second section arranged along the axialdirection from the first section and comprising: an opposing leadingend; and a lateral wall extending between the joint-ward end and theleading end, wherein the lateral wall is configured to engage the bonelayer at the treatment site; penetrating the leading end into the bonelayer to a depth; positioning the second section in the bone layer; andpositioning the joint-ward end in a position to facilitate transmissionthrough the first fenestrations into a cartilage zone by positioning thejoint-ward end at a transition area substantially between a cartilagelayer in the cartilage zone and the bone layer at the treatment sitesuch that the joint-ward end is beneath the cartilage zone or otherwisenot extending entirely through the cartilage zone.
 2. The method ofclaim 1, wherein the lateral wall comprises threads configured to engagethe bone layer at the treatment site.
 3. The method of claim 1, whereinthe lateral wall further comprises second fenestrations configured topromote osseointegration of the second section at the treatment site. 4.The method of claim 1, wherein the first fenestrations promoteintracellular nutrient transmission; or wherein the joint-ward end issubstantially positioned such that cartilage can grow through, around,and over the first fenestrations in the joint-ward end.
 5. The method ofclaim 1, wherein the cartilage is articular cartilage; or wherein thebone layer is a cortical bone base plate.
 6. The method of claim 1,wherein healing includes mitigating bone hypertrophy when the joint-wardend is positioned at the transition area so as to protect against forcesapplied to the body joint.
 7. The method of claim 6, wherein mitigatingbone hypertrophy includes preventing trabecular thickening of cancellousbone.
 8. The method of claim 1, wherein the transition area is locatedsubstantially in a cortical bone base plate; or wherein the transitionarea is located substantially between cancellous bone and the cartilagezone.
 9. The method of claim 1, wherein the device inhibits bone growthinto the cartilage zone when the joint-ward end is positioned at thetransition area; or wherein the device prevents bone fracture when thejoint-ward end is positioned at the transition area thus protectingagainst forces applied to the body joint.
 10. The method of claim 1,wherein at least one of: the body joint is a knee, shoulder, elbow,wrist, hip, spine ankle, or finger; or the treatment site includes asubchondral lesion.
 11. The method of claim 1, wherein the joint isselected from the group consisting of an acetabulofemoral joint, anacromioclavicular joint, a femoropatellar joint, a femorotibial joint, aglenohumeral joint, a humeroradial joint, a humeroulnar joint, aninterphalangeal joint, a metacarpal joint, a radioulnar joint and atalocrural joint.
 12. The method of claim 1, wherein a thickness ofcartilage regrowth at the treatment site is substantially uniform afterhealing; or wherein a thickness of cartilage regrowth at the treatmentsite is substantially the same as a thickness of healthy nativecartilage adjacent the treatment site after healing.
 13. The method ofclaim 1, wherein the device is made at least in part from titanium oralloys thereof.
 14. The method of claim 1, wherein the device is made atleast in part from non resorbable material.
 15. The method of claim 1,wherein the device is made at least in part from polyether-ether-ketone(PEEK).
 16. The method of claim 1, wherein the device is made at leastin part from a partially absorbable material or a fully absorbablematerial.
 17. The method of claim 1, wherein the device is made at leastin part from and/or includes at least one of: biocompatible plastic; abiocomposite polymer; a metal; a metal alloy; carbon fiber; cobaltchrome; nitinol; polycaprolactone (PCL); polyether-ether-ketone (PEEK);tantalum; titanium foam metals; ceramics; ceramic composites; elastomercomposites; elastomer-carbon fiber composites; chambered or fluid-filledmaterials; metal matrices; injectable gels; injectable composites withfluid and solid matrices; bone or bone-composite or allografts; crystalor hydroxyapatite materials; bioabsorbable composites; TCP; PLLA;silicone. biomaterial; biocompatible material; a biocomposite material;a biomimetic material; a bioactive material; a nanomaterial; a partiallyabsorbable material; a fully absorbable material; a tissue formingmaterial; a biphasic material; or a replaceable material.
 18. The methodof claim 1, wherein at least the outer surface of the joint-ward end iscoated with hydroxyapatite.
 19. The method of claim 1, wherein the firstsection and the second section are reversibly attached.
 20. The methodof claim 1, wherein the first section and the second section are fusedtogether.
 21. The method of claim 1, wherein the lateral wall furthercomprises second fenestrations on the second section, wherein the secondfenestrations are between 300 microns and 1200 microns in size.
 22. Themethod of claim 1, wherein the first fenestrations on the joint-ward endof the first section are between 100 microns to 800 microns in size topromote cartilage regrowth.
 23. The method of claim 1, wherein thejoint-ward end is positioned at a boundary of the transition area, saidboundary being located substantially between a cancellous bone and thecartilage zone.
 24. The method of claim 1, wherein the joint-ward endforms a shape that substantially recreates the shape of a normalarticulation surface on the bone after implantation when the joint-wardend is positioned at the treatment site.